Surveillance policy for early detection of failing arteriovenous fistulae for haemodialysis

: We have developed a programme of surveillance for arteriovenous fistulae. Indications for investigation were a reduction of thrill or pulsation on the fistula, decreasing flow ( 150 mmHg.) when on haemodialysis. Between March 1992 and February 1993 we performed intravenous digital subtraction fistulograms in 17 patients. These investigations demonstrated vein stenosis in 11 patients, nine with primary arteriovenous fistulae and in two with secondary access. There was disease of the arterial inflow in one, and no evidence of anatomical problems in the remaining five. As a result revision surgery was performed in 10 cases and percutaneous transluminal angioplasty in the remaining two cases. Five patients underwent dialysis the following day on the same site, avoiding temporary access. Sixteen patients (94%) are still using the same site for haemodialysis at mean follow-up time of 6.1 months (range 2-12 months) and one failed subsequently. Close surveillance of arteriovenous fistulae leads to detection of stenosis prior to occlusion and intervention increases patency, preserves alternative access sites, and prevents central venous cannulation for temporary access.